title: Structured sedation programs in the emergency department, hospital and other acute settings: protocol for systematic review of effects and events.
abstract: BACKGROUND
  The use of procedural sedation outside the operating theatre has increased in hospital settings and has gained popularity among non-anesthesiologists. Sedative agents used for procedural pain, although effective, also pose significant risks to the patient if used incorrectly. There is currently no universally accepted program of education for practitioners using or introducing procedural sedation into their practice. There is emerging literature identifying structured procedural sedation programs (PSPs) as a method of ensuring a standardized level of competency among staff and reducing risks to the patient. We hypothesize that programs of education for healthcare professionals using procedural sedation outside the operating theatre are beneficial in improving patient care, safety, practitioner competence and reducing adverse event rates.
  
  
  METHODS
  Electronic databases will be systematically searched for studies (randomized and non-randomized) examining the effectiveness of structured PSPs from 1966 to present. Database searches will be supplemented by contact with experts, reference and citation checking, and a grey literature search. No language restriction will be imposed. Screening of titles and abstracts, and data extraction will be performed by two independent reviewers. All disagreements will be resolved by discussion with an independent third party. Data analysis will be completed adhering to procedures outlined in the Cochrane Handbook of Systematic Reviews of Interventions. If the data allows, a meta-analysis will be performed.
  
  
  CONCLUSIONS
  This review will cohere evidence on the effectiveness of structured PSPs on sedation events and patient outcomes within the hospital and other acute care settings. In addition, it will examine key components identified within a PSP associated with patient safety and improved patient outcomes.
  
  
  BACKGROUND
  PROSPERO registration number: CRD42013003851.
authors.affiliation: Department of Emergency Medicine, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland. ronan.osullivan1@hse.ie.
authors.forename: Siobhán
authors.initials: S
authors.lastname: McCoy
authors.forename: Abel
authors.initials: A
authors.lastname: Wakai
authors.forename: Carol
authors.initials: C
authors.lastname: Blackburn
authors.forename: Michael
authors.initials: M
authors.lastname: Barrett
authors.forename: Adrian
authors.initials: A
authors.lastname: Murphy
authors.forename: Maria
authors.initials: M
authors.lastname: Brenner
authors.forename: Philip
authors.initials: P
authors.lastname: Larkin
authors.forename: Gloria
authors.initials: G
authors.lastname: Crispino-O'Connell
authors.forename: Savithiri
authors.initials: S
authors.lastname: Ratnapalan
authors.forename: Ronan
authors.initials: R
authors.lastname: O'Sullivan
mesh_terms: D002983:Clinical Competence; D016292:Procedural Sedation / Q000009:adverse effects; D054810:Deep Sedation / Q000009:adverse effects; D004501:Education, Medical; D004636:Emergency Service, Hospital; D006761:Hospitals; D006801:Humans; D010146:Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D012107:Research Design; D012449:Safety; D000078202:Systematic Reviews as Topic